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HomeMy WebLinkAbout125440 1 _ Department of `t' 7y 0 Revenue c�`t. Washington State i - REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. I Tracey Lloyd Filippini,Successor Trustee of the Elmer L.Filippini Revocable Living Trust dated September Joslyn Rhodes,Trustee of The Joslyn Rhodes 2006 Name 10,2007 Name Revocable Trust dated October 24,2006 I:` w w F Mailing Address 415 Kaniksu Shores Road z Mailing Address 3104 Tuxford Lane w a •City/State/Zip Sandpoint,ID 83864 a c„a n pPI a City/State/Zip Modesto,CA 95350-1567 Phone No.(including area code) (360)437-1105 Phone No.(including area code) (209)522-7885 111 Send all property tax correspondence to:❑Same as Bu er/Grantee List all real and personal property tax parcel account Buyer/Grantee —check box if personal property List assessed value(s) Joslyn Rhodes,Trustee of The Joslyn Rhodes 2006 Name Revocable Trust dated October 24,2006& 990603136 0 $205,992.00 Mailing Address 3104 Tuxford Lane 0 City/State/Zip Modesto,CA 95350-1567 0 Phone No.(including area code) (209)522-7885 0 ©Street address of property: 63 Explorer Ln,Port Ludlow,WA 98365-9616 This property is located in®unincorporated Jefferson County OR within 0 city of Port Ludlow 0 Check box if any of the listed parcels are being segregated from another parcel,are part of a boundary line adjustment or parcels being merged. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Lot 136,Area 3,Port Ludlow No.2,as per plat recorded in Volume 5 of Plats,pages 41 through 48,records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 11 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ El 84.36 RCW(nonprofit organization)? 0 YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? 0 ® WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 El property per chapter 84.26 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space, farm and agriculture,or timber) Date of Document May 17,2016 land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 295,000.00 signing below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $ continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 295,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 3,776.00 information. This land 0 does 0 does not qualify for continuance. Local $ 1,475.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 5,251.00 sign (3) below. If the new owner(s) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee $ 5.00 and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 5,256.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® ICE ER PENALT a 'ERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of " S Signature of Grantor or Grantor's gen / _ At , Grantee or Grantee's Agent Tra y Lloyd F ippini,Succe 'or Trustee of the Elmer L.Filippini Revocable Living Joslyn Rhodes,Trustee of The Joslyn Name(print) Trust dated September 10,2007 Name(print) Rhodes 2006 Revocable Trust dated October 24,2006 Date&city of signing: ,c/d9-`6, 4/1/042;e4/A /4 Date&city of signing: Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20,020(IC)). pp .::...;•!5'• "::44 •••512-1- = -.: COUNTY TREASURER 11 .?'(?4,.' 122144 0 Department of Revenue e Washington State • REAL ESTATE EXCISE TAX AFFIDAVIT PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC whe fsn m your ceshiet THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED stamped by cashier. (See back of last page for instructions) ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name. III Elmer L.Filippini,Trustee of the Elmer L.Filippini Joslyn Rhodes,Trustee of The Joslyn Rhodes 2006 Name Revocable Living Trust dated September 10,2007 Name Revocable Trust dated October 24,2006 cc— aC Mailing Address 415 Kaniksu Shores Road Mailing Address 3104 Tuxford Lane a City/State/Zip Sandpoint,ID 83864 5 a City/State/Zip Modesto,CA 95350-1567 Phone No.(including area code) (360)437-1105 �' Phone No.(including area code) (209)522-7885 IIISend all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal property tax parcel account numbers—check box if personal property List assessed value(s) Joslyn Rhodes,Trustee of The Joslyn Rhodes 2006 Name Revocable Trust dated October 24,2006& 990603136 ❑ $205,992.00 Mailing Address 3104 Tuxford Lane 0 City/State/Zip Modesto,CA 95350-1567 ❑ Phone No.(including area code) (209)522-7885 ❑ 0 Street address of property: 63 Explorer Ln,Port Ludlow,WA 98365-9616 This property is located in®unincorporated Jefferson County OR within 0 city of Port Ludlow 0 Check box if any of the listed parcels are being segregated from another parcel,are part of a boundary line adjustment or parcels being merged. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Lot 136,Area 3,Port Ludlow No.2,as per plat recorded in Volume 5 of Plats,pages 41 through 48,records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. Es Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 11 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ 84.36 RCW(nonprofit organization)? YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? 0 ® WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ Reason for exemption Is this property receiving special valuation as historical 0 El property per chapter 84.26 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space,farm and agriculture,or timber) Date of Document May 17,2016 land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 295,000.00 signing below. If the land no longer qualifies or you do not wish to *Personal Property(deduct) $ continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 295,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 3,776.00 information. This land 0 does ❑does not qualify for continuance. Local $ 1,475.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 5,251.00 sign (3) below. If the new owner(s) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee $ 5.00 and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 5,256.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of _— I Grantor or Grantor's Agent Grantee or Grantee's Agent / j Il , Tracy Lloyd Filippini,Successor Trustee of the Elmer L.Filippini Revocable Living Joslyn Rhodes,Trustee of The Joslyn Name(print) Trust dated September 10,2007 Name(print) Rhodes 2006 Revocable Trust dated October 24,2006 7 Date&city of signing: Date&city of signing: ®�� ti• ��; . 9135o Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C)). REV 84 0001a(2/28/13) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER